title: Clinical outcomes after percutaneous coronary intervention in patients with mild versus moderate renal insufficiency at 30-day and 1-year follow-up.
abstract: Percutaneous coronary intervention (PCI) is a standard of care in the management of coronary artery disease in patients with renal insufficiency (RI). However, outcomes of PCI in these patients remain suboptimal with high cardiovascular morbidity and mortality. The studies comparing target vessel revascularization (TVR) after PCI in patients with mild and moderate RI have shown conflicting results. Hence, a meta-analysis of these studies comparing 30-day and 1-year outcomes after PCI was performed. A systematic review of literature revealed 5 studies involving 16,262 patients. Based on the creatinine clearance (CrCl), patients were divided into 2 groups (mild RI, CrCl > 60 mL/min and moderate RI, CrCl of 30-60 mL/min). End points extracted were all-cause mortality, TVR, myocardial infarction, and major adverse cardiac events at 30-day and 1-year follow-up. Combined relative risks (RR) across all the studies and 95% confidence intervals (CIs) were computed. A 2-sided alpha error of <0.05 was considered statistically significant. Both groups had similar baseline characteristics. Rate of TVR at 30 days was significantly lower in the mild RI group than in the moderate RI group (RR, 1.45; 95% CI, 1.04-2.02; P < 0.05). However, rate of TVR at 1-year follow-up was similar in both groups (RR, 1.02; 95% CI, 0.94-1.11; P, nonsignificant). Incidence of all-cause mortality, TVR, myocardial infarction, and major adverse cardiac events remained higher in the moderate RI group both at 30-day and 1-year follow-up (P < 0.05 for all outcomes). Patients with moderate RI have higher morbidity and mortality at 30 days and 1 year after PCI compared with patients with mild RI. However, there is no difference in the incidence of TVR after PCI at 1 year between the 2 groups.
authors.affiliation: Department of Cardiology, Chicago Medical School, North Chicago, IL.
authors.forename: Mukesh
authors.initials: M
authors.lastname: Singh
authors.forename: Param
authors.initials: P
authors.lastname: Singh
authors.forename: Puneet
authors.initials: P
authors.lastname: Grewal
authors.forename: Daniela
authors.initials: D
authors.lastname: Kovacs
authors.forename: Janos
authors.initials: J
authors.lastname: Molnar
authors.forename: Rohit
authors.initials: R
authors.lastname: Arora
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khosla
mesh_terms: D003324:Coronary Artery Disease / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D051437:Renal Insufficiency / Q000503:physiopathology*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome